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I think there is also another factor that causes her to spawn... but I can't pinpoint it cause I've only had her spawn in Chapter 3 (3 times even though i triggered her dream sequence in all places I could) but my friend had her popping up everywhere except in the marrow.
So there must be an extra factor that causes her to spawn more or less...
She is in the marrow if you open an optional area in the med bay area.
*edit* ohh that's right, the labs. That's the final encounter with her
I finished every other side quest in Union quietly, cleared out the whole town and left triggering her for last before going to the pit stop in the upper right of the map. She doesn't exist in Union until you pick up the diary in that house.
If you don't ever trigger her, I wonder how that plays out through the rest of the game since if you do trigger her, later down the road you're trapped in a small room with her, hospital equipment she keeps moving around and body storage chambers which open to block your path. Never died so many times in a row other than that one small downstairs room.
Playing nightmare difficulty right now, the lost really take a good beating and you don't have the icons when they hear/see you. I think Survival mode was too easy.